Cynulliad Cenedlaethol Cymru

National Assembly for Wales

Y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon

Health, Social Care and Sport Committee

Ymchwiliad I wasanaethau Nyrsio Cymunedol a Nyrsio Adal

Inquiry into Community and District Nursing services

HSCS(5) CDN06

Ymateb gan Health Education and Improvement Wales

Evidence from Health Education and Improvement Wales

1.                  INTRODUCTION

Health Education and Improvement Wales welcomes the opportunity to provide evidence to the Health, Social Care and Sport’s Committee inquiry into ‘the activity of district nurse-led community nursing teams and the quality of nursing care provided to people in their own homes’.

Heath Education and Improvement Wales was established as a Special Health Authority on 1 October 2018, bringing together the Wales Deanery, the Wales Centre for Pharmacy Professional Education and the NHS Workforce and Education Development Service.

HEIW sits alongside Health Boards and Trusts, and has a leading role in the education, training, development, and shaping of the healthcare workforce in Wales, in order to ensure high-quality care for the people of Wales.

2.                KEY INFORMATION

2.1              Shape and size of the workforce

The community nursing workforce (registered nurses) has grown significantly over the past decade:

·         The overall community nursing workforce (registered nurses across adult, psychiatry and learning disabilities) has increased by 37% since 2009 from 3,402 wte to 4,655 wte in 2018

·         The number of registered nurses working in the community (adult) has increased by 48% since 2009 from 2,090 wte to 3,084 wte in 2018.

·         The number of registered nurses with a recordable SPQ qualification has reduced by 17% since 2009 from 690 wte to 590 wte in 2018 

·         46% of the community nursing workforce are aged 50 and over

2.2            Education requirements

NHS Wales and the Welsh Government agreed in 2008 that the Specialist Practice Qualification (SPQ) would not be the only qualification which would be recognised to demonstrate an individual can fulfil a community nursing role at band 6/7. Registered nurses without an SPQ can work to the same level as a District Nurse and lead a community nursing team but cannot call themselves a District Nurse.

2.3            Education provision

HEIW provides funding for the following postgraduate education:

·         Advanced/Extended Practice education to the sum of £1.25 million, of this £750K is targeted towards staff education within the primary care/community/ general practice environments

·         Non-medical prescribing education to the sum of £300,000, this budget allows HEIW to commission approximately 230 programmes from the universities across Wales

·         Specialist Practice Nursing and Community Public Health Nurse education £4.3 million

In addition to the above the Welsh Government have committed to investing £2 million per year over 2018/19 and 2019/20 to support a neighbourhood District Nursing pilot.  £1.4 million of this funding has been allocated to HEIW to support the education and training programmes required to underpin the pilot and support the release of nurses to train as district nurses or equivalent. 

3.                SPECIFIC ISSUES IDENTIFIED BY THE ENQUIRY

3.1              Whether we have a clear picture of the district nursing and community nursing workforce in Wales, and the level of need for community nursing services (including future need). Do we have the evidence base to support effective workforce planning.

Response

All health boards and trusts are required to produce a workforce plan (IMTP) each year, which includes completion of an education-commissioning template. This template clearly articulates the numbers of training places the organisation has deemed that will be required to maintain the workforce for the future. This data informs the commissioning process.

There is annual investment in education to ensure a supply of registered nurses to work within community teams. As identified above HEIW commission Specialist Practice Qualifications and Community Health Degrees from universities within Wales. In addition, HEIW commission modular education to support the acquisition of appropriate knowledge and skills to enhance the skill mix of community nursing teams, which can support the development of new services.

3.2            Whether there is clear strategy, at national and local levels, about the future direction for district nurse-led community nursing services. How well aligned is this with the development of the primary care cluster model for example, and with the vision for health and care services set out in A Healthier Wales.

Response

Welsh Government have commissioned the Neighbourhood District Nursing pilot: with a target to train an additional 80 District Nurses during the period 2018-20.

In 2018 A Healthier Wales: our Plan for Health and Social Care was published; this superseded the previous Primary Care Workforce Action Plan and the key areas of focus going forward were prioritised and outlined in The Strategic Programme for Primary Care (November 2018).  Within this strategic overview primary care is defined as “…those services which provide the first point of care, day or night… It is about coordinating access for people to the wide range of services in the local community to help meet their health and wellbeing needs.…including a very wide range of staff, such as community and district nurses, midwives…” 

3.3            How effectively community-nursing teams are able to work with a range of professionals and agencies (including primary and secondary care services, social care services, and the voluntary sector) to deliver seamless, person-centred care.

Response

HEIW commission post graduate education for a broad range of clinicians, which includes a ring-fenced budget for staff working in community and primary care settings.

This funding supports nurses and other professionals to access education to develop advanced or extended knowledge and skills that can support and enhance the services delivered by community nursing services. Increasingly this education is delivered in multi-professional / interdisciplinary training programmes.

4.                SUPPLEMENTARY INFORMATION

4.1              Specialist Community Nursing Courses

In the 1990s, the Nursing and Midwifery Council (NMC) developed standards for community nurse education.  These Specialist Practice Qualifications (SPQ) are recordable with the NMC but are not registerable qualifications. The NMC have recently announced that a review of specialist practice education will be undertaken within the next 2 years.

The specialist community nursing education courses that HEIW currently commissions and funds on a part time or modular route, are those that lead to either:

·         a Specialist Practice Qualification (SPQ) recordable with the NMC or

·         BSc/PG Dip Community Health Studies degree.

Community nursing education courses can be undertaken in a number of specialist areas.  These include:

·         General Practice Nursing (for those who work in a GP surgery where the GP is the employer or those employed by an NHS Organisation), and

·         District Nursing; Community Paediatric Nursing; Community Psychiatric Nursing; Community Learning Disability Nursing.

There are two routes to achieving the SPQ/Community Health Studies awards:

·         The part time route usually completed over a period of 2 years.

Or

·         The modular route, which allows students to undertake one or more specific taught modules over an undefined period.  Students following the modular route complete the Fundamentals of Community Practice, as their first module.  On completion of this module, students can choose whether to complete another module(s) or exit from the programme.

Whilst the SPQ is a recognised position, as identified by the NMC and the profession, fundamentally it is up to the employer to decide and agree with their staff what skills and knowledge are required to discharge their role effectively.

The table below identifies the number of places commissioned for district/community nursing and the uptake of these places across Wales

DISTRICT/COMMUNITY NURSING

 

Part-time commissions

Part-time uptake

Modules commissioned

Modules uptake

2018.19

80

Detail not yet available

123

Detail not yet available

2017.18

80

61

123

128

2016.17

41

39

123

88

2015.16

41

41

123

84

4.2            Primary Care Healthcare Support Worker (HCSW) Development

Developing a flexible and sustainable support workforce requires access to the necessary education, skills and training.  Using the skills and talents of existing unregistered HCSWs and offering improved development opportunities, especially to meet new service requirements, is a key component in securing the workforce of the future. 

A standardised Level 3 certificate and diploma programme of accredited training for primary care HCSWs in Wales has been developed.  The programme enables career progression; facilitates skill mix; supports future service delivery; and aligns with:

·         NHS Wales Skills and Career Development Framework

·         Royal College of General Practitioners’ Competency Framework for Healthcare Assistants

Work is ongoing to broaden opportunities for role development of HCSWs in primary care, with access to wider ranging units of learning that reflect new and emerging service delivery models e.g. HCSWs to support advanced practice physiotherapists; training of navigator reception staff.

4.3            Workforce information

The information within this section has been extracted from the ESR Data Warehouse based on the staff in post at Dec 2009 – 2018.

Key points:

The tables below demonstrate changes to the workforce over this period of time.